Zhonghua Yi Xue Za Zhi. 2026 Oct 13;106(37):4009-4017. doi: 10.3760/cma.j.cn112137-20260607-01475.
ABSTRACT
Objective: To investigate the relationship between the atherogenic index of plasma (AIP) during mid-pregnancy and abnormal glucose metabolism (AGM) in early postpartum period among women with previous gestational diabetes mellitus (GDM). Methods: In this retrospective cohort study, women with previous GDM who attended the Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, between December 2014 and June 2021 were recruited. Based on the outcomes of the 75 g oral glucose tolerance test (OGTT) performed at 4 to 12 weeks postpartum, the patients were classified into normal glucose tolerance (NGT) group and AGM group. Demographic characteristics, glycemic and lipid profiles, and AIP levels at mid-pregnancy and postpartum were compared between the two groups. Logistic regression analysis was used to identify the risk factors for postpartum AGM, and restricted cubic spline (RCS) analysis was performed to assess the dose-response relationship between mid-pregnancy AIP and postpartum AGM. Results: Finally, 921 women completed follow-up at 4 to 12 weeks postpartum, among whom 626 (68.0%) exhibited NGT and 295 (32.0%) were diagnosed with AGM.Compared with the NGT group, the AGM group had significantly higher AIP levels during both mid-pregnancy and postpartum peroid (P<0.05). Logistic regression identified age, insulin therapy during pregnancy, mid-pregnancy fasting plasma glucose (FPG), and AIP were independent risk factors for postpartum AGM; each 1 unit increase in AIP was associated with a 237.6% increased risk of postpartum AGM (OR=3.376, 95%CI: 1.431 to 7.964, P<0.01). After full adjustment for age, pre-pregnancy body mass index (pre-BMI), gestational weight gain rate, diabetic family history, insulin therapy during pregnancy, FPG, low-density lipoprotein cholesterol (LDL-C), and total cholesterol (TC), each 1-standard-deviation (SD) increase in the Z-score-standardized AIP was associated with a 25.3% increased risk of postpartum AGM (OR=1.253, 95%CI: 1.069 to 1.470, P<0.01). RCS analysis demonstrated a linear positive association between mid-pregnancy AIP and the risk of postpartum AGM (P for overall=0.020; P for nonlinearity=0.697). When mid-pregnancy AIP>0.093, the risk of postpartum AGM showed an increasing trend. Subgroup analyses stratified by age (<35 vs ≥35 years), pre-BMI (<24 vs ≥24 kg/m2), and insulin therapy during pregnancy (yes vs no) revealed that there was no interaction between mid-pregnancy AIP levels and the risk of AGM across any of the subgroups (all P for interaction>0.05). Conclusion: Mid-pregnancy AIP level was independently and positively correlated with the risk of early postpartum AGM in women with GDM.
PMID:42855770 | DOI:10.3760/cma.j.cn112137-20260607-01475